Healthcare Provider Details

I. General information

NPI: 1891590253
Provider Name (Legal Business Name): YASIN YIZU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11410 NE 122ND WAY
KIRKLAND WA
98034-6945
US

IV. Provider business mailing address

11758 GREENWOOD AVE N APT 6
SEATTLE WA
98133-8146
US

V. Phone/Fax

Practice location:
  • Phone: 425-650-4005
  • Fax:
Mailing address:
  • Phone: 206-805-9194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN61173500
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: